| Model Instance Name: | 
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		| Embassy Enterprise | 
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		| MID: | 
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		| Date: | 1/4/2010 | 
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		| Model questions utilize the ACSI methodology to determine scores and impacts | 
	
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 | ELEMENTS (drivers of satisfaction) | 
 | CUSTOMER SATISFACTION | 
 | FUTURE BEHAVIORS | 
	
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 | Content (1=Poor, 10=Excellent, Don't Know) | 
 | Satisfaction | 
 | Return (1=Very Unlikely, 10=Very Likely) | 
	
		| 1 | Please rate the perception of accuracy of information on this site. | 17 | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)
 | 20 | How likely are you to return to this site? | 
	
		| 2 | Please rate the quality of information on this site. | 18 | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)
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 | Recommend (1=Very Unlikely, 10=Very Likely) | 
	
		| 3 | Please rate the freshness of content on this site. | 19 | How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)
 | 21 | How likely are you to recommend this site to someone else? | 
	
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 | Look and Feel (1=Poor, 10=Excellent, Don't Know) | 
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 | Trust (1=Strongly Disagree, 10=Strongly Agree) | 
	
		| 4 | Please rate the visual appeal of this site. | 
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 | 22 | I can count on this Embassy to act in my best interests. | 
	
		| 5 | Please rate the balance of graphics and text on this site. | 
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 | 23 | I consider this Embassy to be trustworthy. | 
	
		| 6 | Please rate the readability of the pages on this site. | 
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 | 24 | This Embassy can be trusted to do what is right. | 
	
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 | Navigation (1=Poor, 10=Excellent, Don't Know) | 
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 | Future Participation (1=Very Unlikely, 10=Very Likely) | 
	
		| 7 | Please rate how well the site is organized. | 
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 | 25 | How likely are you to express your thoughts or ideas to this Embassy in the next 90 days? | 
	
		| 8 | Please rate the options available for navigating this site. | 
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		| 9 | Please rate how well the site layout helps you find what you are looking for. | 
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		| 10 | Please rate the number of clicks to get where you want on this site. | 
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 | Online Transparency (1=Poor, 10=Excellent, Don't Know) | 
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		| 11 | Please rate how thoroughly this website discloses information about what this Embassy is doing. | 
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		| 12 | Please rate how quickly Embassy information is made available on this website. | 
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		| 13 | Please rate how well information about this Embassy's actions can be accessed by the public on this website. | 
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 | Site Performance (1=Poor, 10=Excellent, Don't Know) | 
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		| 14 | Please rate how quickly pages load on this site. | 
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		| 15 | Please rate the consistency of speed from page to page on this site. | 
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		| 16 | Please rate the ability to load pages without getting error messages on this site. | 
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		| #REF! | 
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 | red & strike-through:  DELETE | 
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		| #REF! | 
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 | underlined & italicized: RE-ORDER | 
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		| #REF! | 
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 | pink: ADDITION | 
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		| Date: | 1/4/2010 | blue + -->: REWORDING | 
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		| #REF! | 
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		| QID (Group ID)
 | Skip Logic Label | Question Text | Answer Choices (limited to 50 characters)
 | Skip to | Type (select from list) | Single or Multi | Required Y/N
 | Special Instructions | 25 character limit. Leave blank if you want DOT to fill this part out.
		CQ Label | 
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 | How frequently do you visit this site? | First time | 
 | Radio button,  one-up vertical | Single | Y | 
 | Visit Freq | 
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 | More than once a day | 
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 | About once a week | 
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 | About once a month | 
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 | Every 6 months or less | 
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 | How do you locate content? | Use the bread crumb | 
 | Radio button,  one-up vertical | Single | Y | 
 | Find Content | 
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 | Use the navigation buttons | 
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 | Use the search feature | 
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 | Use the site map | 
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 | How did you learn about this site? | Web page ad | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn | 
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 | Brochure (Print) | 
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 | Email hyperlink | 
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 | Blog | 
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 | Link from another site | 
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 | Internet search engine | 
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 | Word of mouth | 
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 | Did you find what you were looking for? | Yes | 
 | Radio button,  one-up vertical | Single | Y | OPS Group | Did you find | 
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 | No | 
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 | Did you come to the Embassy website today to find information about passports or visas? | Yes | 
 | Radio button,  one-up vertical | Single | Y | OPS Group | Purpose Passport Visa | 
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 | No | C | 
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 | C | What was your purpose for coming to site today? | 
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 | Text area,  no char limit | 
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 | Purpose | 
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 | Where are you located? | Africa | 
 | Radio button,  one-up vertical | Single | Y | OPS Group | Location | 
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 | East Asia and Pacific | 
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 | Europe and Eurasia | 
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 | Latin America | 
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 | Middle East and North Africa | 
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 | North America | 
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 | South Asia | 
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 | In what country are you located? | 
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 | Text field,  <100 char | Single | N | 
 | Name of Country | 
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 | What is your gender? | Female | 
 | Radio button,  one-up vertical | Single | Y | 
 | Gender | 
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 | Male | 
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 | Prefer not to respond | 
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 | What is your age range? | Under 14 | 
 | Radio button,  one-up vertical | Single | Y | 
 | Age | 
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 | 14 - 18 | 
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 | 19 - 30 | 
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 | 31 - 50 | 
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 | Over 50 | 
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 | Prefer not to respond | 
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 | By coming to this website today, did you learn something about life in the United States? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Life | 
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 | No | 
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 | By coming to this website today, did you learn something about U.S. foreign policy? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Policy | 
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 | No | 
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 | Did you learn something today on this website that you will share with someone else? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Share | 
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 | No | 
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 | By coming to this website today, did you learn something about the values of the U.S. people? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Values | 
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 | No | 
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 | Do you read books, newspapers, or magazines from the United States? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Read | 
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 | No | 
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 | Do you watch U.S. television shows or movies? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Media | 
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 | No | 
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 | Do you listen to U.S. music? | Yes | 
 | Radio button,  one-up vertical | Single | Y | 
 | Learn Music | 
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 | No | 
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 | What is your opinion of the United States. | Very unfavorable | 
 | Radio button,  scale, no don't know | Single | Y | 
 | Opinion | 
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 | Somewhat unfavorable | 
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 | Somewhat favorable | 
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 | Very favorable | 
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 | Please indicate your level of agreement with the statement,   "The United States is a trustworthy partner for your country." | Strongly Disagree | 
 | Radio button,  scale, no don't know | Single | Y | 
 | Trustworthy | 
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 | Disagree | 
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 | Neither Agree nor Disagree | 
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 | Agree | 
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 | Strongly Agree | 
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 | Please indicate your level of agreement with the statement,    "The United States treats your country with respect." | Strongly Disagree | 
 | Radio button,  scale, no don't know | Single | Y | 
 | Treat with respect | 
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 | Disagree | 
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 | Neither Agree nor Disagree | 
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 | Agree | 
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 | Strongly Agree | 
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 | To what extent do you think the United States listens to the views of other countries? | Not at all | 
 | Radio button,  scale, no don't know | Single | Y | 
 | Listen to views | 
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 | Not very much at all | 
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 | A fair amount | 
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 | A great deal | 
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		| Types | 
 | Instructions | 
	
		| Text field,  <100 char | 
 | Randomize | 
	
		| Text area,  no char limit | 
 | Shared | 
	
		| Drop down,  select one | 
 | OPS Group | 
	
		| Radio button,  one-up vertical | 
 | Matrix Group | 
	
		| Radio button,  two-up vertical | 
 | Rank Group | 
	
		| Radio button,  three-up vertical | 
 | Comparative Matrix Group | 
	
		| Radio button,  scale, has don't know | 
 | Skip Logic Group | 
	
		| Radio button,  scale, no don't know | 
 | Multiple Lists Group | 
	
		| Checkbox,  one-up vertical | 
 | Anchor Answer Choice | 
	
		| Checkbox,  two-up vertical | 
 | Partitioned | 
	
		| Checkbox,  three-up vertical | 
 | Adjust Template/Style Sheet |